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Uptodate Reference Title
Multiple outcomes of patients with acute bloody diarrhea and suspected STEC infection
Multiple outcomes of patients with acute bloody diarrhea and suspected STEC infection
This figure portrays the sequence of events following presentation with acute bloody diarrhea and the impact of clinical course and microbiologic testing on clinical management. Circles with dashed outlines reflect uncertain risk, circles with thin outlines represent low or no risk, and circles with thick outlines signify high-risk situations. Refer to other UpToDate content for details on the management of suspected or documented STEC.
STEC: Shiga toxin-producing Escherichia coli; HUS: hemolytic uremic syndrome. * In this situation, STEC infection is very unlikely. If diarrhea persists but within a few hours is no longer bloody, STEC infection is also very unlikely. We consider discharge if the patient's condition permits. ¶ High-risk STEC refers to E. coli that contain a gene encoding Shiga toxin 2. All E. coli O157:H7 should be assumed to contain a gene encoding Shiga toxin 2. Δ The risk of severe disease and HUS is uncertain when Shiga toxin is detected but the genotype is not yet reported. We manage patients as if they have infection with high-risk STEC unless it is confirmed that the STEC does not contain a gene encoding Shiga toxin 2. Determination of Shiga toxin genotype is not always available, and patients frequently improve before such microbiologic information is reported to the provider. ◊ If an STEC is detected, but it does not contain a gene encoding Shiga toxin 2, it is not a high-risk STEC. E. coli containing a gene encoding Shiga toxin 1 rarely, if ever, cause HUS. § If an STEC is excluded and another pathogen is identified (or no pathogen is identified), the possibility of STEC should no longer influence management of the patient.
